Continuing Medical Education

The diagnosis, management and prevention of HIV-associated tuberculosis

S Wasserman, G Meintjes

Abstract


Tuberculosis (TB) and its strong association with HIV infection are the most important causes of the high rates of infectious morbidity and mortality in South African adults. The interaction between HIV and TB leads to more frequent smear-negative and extrapulmonary disease, resulting in atypical clinical presentations and altered performance characteristics of diagnostic tests. New and emerging diagnostics are being used to support earlier initiation of therapy and detection of drug resistance, although these have inherent limitations and empirical therapy is often still required. The management of HIV-associated TB is complicated by rapid clinical progression of disease, immune reconstitution inflammatory syndrome, drug-drug interactions and shared toxicities. A strong evidence base now provides guidance on the timing of initiation of antiretroviral therapy, the use of corticosteroids in TB and the use of isoniazid preventive therapy. This article provides a clinically oriented overview of the diagnosis, management and prevention of HIV-associated TB, with a focus on recent evidence in the field.


Authors' affiliations

S Wasserman, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

G Meintjes, Clinical Infectious Disease Research Initiative, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Medicine, Imperial College London, UK

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Keywords

HIV; Tuberculosis

Cite this article

South African Medical Journal 2014;104(12):886-893. DOI:10.7196/SAMJ.9090

Article History

Date submitted: 2014-10-27
Date published: 2014-11-06

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